Ortho Case of the Week – Pelvis ANSWERS

Case 1: A 40-year-old male is BIBEMS after an MCC.

1. Describe the pathology on the x-ray above.

Open book pelvic fracture.

Typically results from high energy trauma with anterior-posterior compression of the pelvis, resulting in widening of the public symphysis. Commonly associated with life-threatening vascular injuries.

No diastasis of the SI joints in the above case, but when the pubic symphysis diastasis is >2.5 cm, the anterior sacroiliac ligaments are usually disrupted.

Case 2: A 21-year-old male is BIBEMS after an MCC.

2. Describe the pathology on the x-ray above.

This xray demonstrates left superior and inferior rami fractures and ipsilateral posterior ilium fracture-dislocation resulting from lateral compression.

Case 3: A 35-year-old male is BIBEMS after an MVC. His left leg is shortened.

3. Describe the pathology on the x-ray above.

Malgaigne pelvic fracture, defined by two injuries to the pelvic ring on the same side: one anterior to the acetabulum and one posterior. This results in an unstable lateral fragment containing the acetabulum. Results from vertical shear force.

This patient has injuries to the left SI joint and ipsilateral ischiopubic ramus with vertical displacement and instability.

This fracture pattern is typically associated with a fall from >10 feet and is associated with the highest risk of hypovolemic shock and has a mortality rate up to 25%.

Types of pelvic fractures:

4. In what type of pelvic fracture should you use a pelvic binder?

Use in an unstable pelvic fracture.

Risk of worsening a lateral compression fracture or in fractures with an internal rotation component, resulting in increased bleeding and hollow viscous injury.

5. What is the correct placement of a pelvic binder?

Over the greater trochanters.